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CEUS examinations were conducted pre-treatment at baseline (week 0) and at weeks 2, 4, 6 and 8 post-treatment, with one target lesion consistently monitored throughout the therapeutic course. Perfusion parameters were derived using SonoLiver software. The reductions (\u0394) and ratios of these parameters from baseline to each subsequent follow-up time point were compared between responders and non-responders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      According to mRECIST criteria, 83 patients (training cohort:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200962, validation cohort:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200921) and 56 patients (training cohort:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200943, validation cohort:\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913) were classified as responders and non-responders, respectively. In the training cohort, responders demonstrated significantly smaller tumor diameters compared to non-responders beginning at week 4 (4.6\u2009\u00b1\u20092.3\u00a0cm vs. 5.4\u2009\u00b1\u20092.8\u00a0cm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.027). From week 2 onward, the reductions and ratios of maximum intensity (IMAX) and area under curve (AUC) in responders were significantly higher compared to non-responders. At all time points (weeks 2, 4, and 6), the diagnostic performance of IMAX and AUC ratios was superior to that of \u0394IMAX and \u0394AUC. Furthermore, the AUROCs of IMAX and AUC ratios at week 4 were significantly higher than those at week 2 (Z\u2009=\u20093.531,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05; Z\u2009=\u20093.550,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05, respectively) and comparable to those at week 6 (Z\u2009=\u20091.596,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.11; Z\u2009=\u20091.566,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.12, respectively). In the validation cohort at week 4 post-treatment, the AUROCs of IMAX and AUC ratios were 0.896 and 0.905 (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), with corresponding accuracies of 85.3% and 85.3%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The ratios of AUC and IMAX at week 4 post-treatment may serve as reliable early predictors of treatment response to chemotherapy combined with Cetuximab in patients with CRLM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-026-04902-6","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T03:35:28Z","timestamp":1778297728000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early prediction of response to chemotherapy with Cetuximab in colorectal liver metastasis with contrast-enhanced ultrasound perfusion analysis"],"prefix":"10.1186","volume":"26","author":[{"given":"Najiao","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peishan","family":"Guan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daohui","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longhui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewu","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiqin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"issue":"1","key":"4902_CR1","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s40644-023-00547-w","volume":"23","author":"S Li","year":"2023","unstructured":"Li S, Yuan L, Yue M, et al. 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For minor participants, consent was obtained from their respective parents or legal guardians. All case reports within the manuscript are accompanied by valid consent documentation.Either institutional consent forms or the journal-provided template were used, as applicable. These documents are retained by the authors and will be made available promptly upon request by the editorial office at any stage, including post-publication.The authors take full responsibility for ensuring compliance with ethical guidelines regarding the use of personal data in this submission.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"398"}}